Left‑Atrial Appendage Occlusion versus Direct‑Oral Anticoagulation for Stroke Prevention in Atrial Fibrillation

Abstract 2294800, presented at Western Atrial Fibrillation Symposium 2026

Left-atrial appendage occlusion (LAAO) devices are an alternative to long‑term anticoagulation for stroke prevention in AF, but comparative effectiveness versus direct‑oral anticoagulants (DOACs) is not fully established.PubMed, Embase, ClinicalTrials.gov and cardiovascular meeting abstracts were searched for randomized or observational studies comparing LAAO with DOAC therapy. Outcomes included stroke/systemic embolism, major bleeding, procedural complications and all‑cause mortality. Hazard ratios were pooled using random‑effects models.Eleven studies (three randomized, eight observational) enrolling 8,200 patients were included. Over a median 2.5‑year follow‑up, stroke/systemic embolism was comparable between LAAO and DOACs (HR 0.95, 95% CI 0.78–1.16). Major bleeding was lower with LAAO (HR 0.70, 95% CI 0.56–0.88). Procedural complications occurred in 4.3% of LAAO patients, primarily pericardial effusion and device embolization. Mortality did not differ significantly between groups.LAAO offers stroke prevention similar to DOAC therapy with reduced major bleeding, but procedure‑related complications must be considered. Patient selection should take into account bleeding risk, left‑atrial anatomy and operator experience.